Tooth Loss and Periodontal Disease Predict Poor Cognitive Function in Older Men

OBJECTIVES To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men. DESIGN Prospective study. SETTING Community-dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study. PARTICIPANTS Five hundred ninety-seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years. MEASUREMENTS Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age- and education-specific median on the Mini-Mental State Examination (MMSE) and less than 10 points on a spatial copying task. RESULTS Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01-1.18) and low spatial copying score (HR=1.12, CI=1.05-1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01-1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01-1.09; spatial copying: HR=1.04, CI=1.01-1.06), and caries (spatial copying: HR=1.05, CI=1.01-1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men. CONCLUSION Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.